P.O. BOX 07, RAJAWELLA, DIGANA, SRI LANKA.
Tel : +94 (0)81 2376 376/ +94(0)727 258 730



Membership Category


OrdinaryOverseasCoporateJuniorVilla Site / ResidentFamily



Personal Information (Primary Applicant)


Surname:
First Name:
Other Names:
Sex:
Date of Birth (mm/dd/yyyy) :
Nationality:
If other, please specify:
NIC Number / Passport Number:
Profession:
Designation:



Contact Details (Primary Applicant)

Residential Address:
Residential Telephone Number:
Mobile Number:
Personal E-mail Address:
Company / Business Address:
Company / Business Number:
Company / Business Mobile:
Company / Business E-mail Address:



Personal Information (Spouse) (Family Membership Only)


Surname:
First Name:
Other Names:
Sex:
Date of Birth (mm/dd/yyyy):
Nationality:
If other, please specify:
NIC Number / Passport Number:
Profession:
Designation:



Personal Information (Child 1) (Family Membership Only)


Surname:
First Name:
Other Names:
Sex:
Date of Birth (mm/dd/yyyy):
Nationality:
If other, please specify:
NIC Number / Passport Number:
Profession:
School:



Personal Information (Child 2) (Family Membership Only)


Surname:
First Name:
Other Names:
Sex:
Date of Birth (mm/dd/yyyy):
Nationality:
If other, please specify:
NIC Number / Passport Number:
Profession:
School:



Golf (Primary Applicant)

Do you play golf?
Please provide your handicap



Other details

Other Club Memberships: (Please list down other memberships and the time period held)


Have you ever been refused admission/ suspended/ terminated from any club in Sri Lanka or overseas? (If yes, please provide an explanation)



Proposer

Name:
Membership No:
Golf Handicap:
Length of time known to proposer:
years
Date:



Seconder

Name:
Membership No:
Golf Handicap:
Length of time known to proposer:
years
Date:



Declaration

I declare that the details provided herewith are true and understand that if found to be false, will lead to the loss of membership at Victoria Golf and Country Resort. I understand that this application form does not constitute to a confirmed membership and will only assist in securing a membership.


I have attached herewith a copy of my CV, NIC/ Passport Copy, twopassport size pictures and any other documentation that may be considered favorable for my request.